神经内窥镜与开颅手术治疗高血压脑出血的疗效比较

Curative effect comparison of endoscopic surgery and craniotomic hematoma evacuation in manage- ment of hypertensive intracerebral hemorrhage

目的探讨神经内窥镜与开颅血肿清除两种手术方法治疗基底节区高血压脑出血疗效的差异。 方法分析70例血肿量在30～40 ml基底节区高血压脑出血手术病例，随机分为内镜组30例和开颅组40例。比较内镜组和开颅组患者在头皮切口、骨窗大小、皮层切口、失血量、手术时间、血肿清除率、颅内感染率、死亡率及Barthel指数的差异。 结果内镜组与开颅组头皮切口长度分别为（5.40±0.97）、（24.50±3.88） cm，两组比较差异有统计学意义（t＝26.310，P＝0.000）。内镜组与开颅组骨窗大小分别为（12.5±2.2）、（63.3±12.3） cm2，两组比较差异有统计学意义（t＝22.320，P＝0.000）。内镜组与开颅组皮层切口分别为（1.05±0.45）、（2.40±0.52） cm,两组比较差异有统计学意义（t＝11.385，P＝0.000）。内镜组与开颅组失血量分别为（80.0±18.3）、（339.0±90.3） ml，两组比较差异有统计学意义（t＝15.450，P＝0.000）。内镜组与开颅组手术时间分别为（0.96±0.31）、（4.35±0.57） h,两组比较差异有统计学意义（t＝24.440，P＝0.001）。内镜组与开颅组患者血肿清除率分别为（81.00±7.93）%、（92.40±6.15）%，两组比较差异无统计学意义（t＝6.777，P＝0.138）。内镜组及开颅组再出血率分别为7.5%、6.7%,两组比较差异无统计学意义（χ2＝0.018，P＝1.000）。内镜组及开颅组死亡率分别为5%、6%,两组比较差异无统计学意义（χ2＝0.088，P＝1.000）。内镜组及开颅组感染率分别10%、15%，两组比较差异无统计学意义（χ2＝1.350，P＝0.723）。内镜组及开颅组Barthel指数分别为75.34±20.51、55.30±10.20,两组比较差异有统计学意义（t＝1.350，P＝0.000）。 结论对于出血量在30～40 ml基底节区高血压脑出血患者，神经内镜手术创伤小，手术时间短、预后良好，但血肿清除率较开颅手术低。

Objective To investigate and compare the curative effect of endoscopic management and craniotomic hematoma evacuation in hypertensive intracerebral hemorrhage （HICH）. Methods Sev- enty cases of HICH were randomly divided into 2 groups： endoscopy group （30 cases ） and craniotomy group （40 cases）. In the patients with intracerebral hematoma volume of 30 -40 ml, the therapeutic effect was compared between two groups ： incision of scalp, bone window, cortical incision, blood loss, operating duration, rate of hematoma evacuation, rate of rehemorrhage, rate of intracranial infection, mortality and Barthel index. Results The length of scalp incision in endoscopy group and craniotomy group was （ 5.40 ± 0. 97 ） cm and （ 24. 50 ± 3.88 ） cm, comparison between the two groups was statistically signifi- cant （t =26. 310, P =0. 000）. The area of bone window in endoscopy group and craniotomy group was （12. 5 ± 2. 2） cm2 and （63.3 ± 12. 3 ） cm2 respectively, comparison between the two groups was statistically significant （ t = 22. 320, P = 0. 000 ）. The length of cortical incision in endoscopy group and cranioto- my group was （ 1.05± 0. 45 ） cm and （2.40 ±0. 52） cm respectively, comparison between the two groups was statistically significant （ t = 11. 385, P = 0. 000 ）. The blood loss in endoscopy group and craniotomy group was （80. 0± 18.3） ml and （339.0 ±90. 3） ml respectively, comparison between the two groups was statistically significant （t = 15.450, P = 0. 000 ）. The time of operating duration in endoscopy group and craniotomy group was （0. 96 ± 0. 31 ） h and （4. 35 ± 0. 57 ） h respectively, comparison between the two groups was statistically significant （ t = 24. 440, P =0. 001 ）. The rates of hematoma evacuation in endosco-py group and craniotomy group was （81.00 ± 7.93 ）% and （92. 40 _± 6. 15 ）% respectively, comparison between the two groups was not statistically significant （χ2 = 6. 777, P = 0. 138 ）. Rates of rehemorrhage in endoscopy group and craniotomy group was 7. 5% and 6.7% respectively, comparison between the two groups was not statistically significant （χ2 = 0. 018, P = 1. 000）. The rates of intracranial infection in en- doscopy group and craniotomy group was 10% and 15% , comparison between the two groups was not statis- tically significant （χ2 = 1. 350, P = 0. 723 ）. Death rates in endoscopy group and craniotomy group was 5% and 6% respectively, comparison between the two groups was not statistically significant （χ2 = 0. 088, P = 1. 000）. Barthel index in endoscopy group （75.34 ±20. 51 ） was higher compared with craniotomy group （55. 30 ± 10. 20 ）. Comparison between the two groups was statistically significant （ t = 1. 350, P = 0. 000）. Conclusion For the patients with intracerebral hematoma volume 30 -40 ml, endoscopic sur- gery has the advantages including minimally invasive, short operating duration and good prognosis, but it has lower hematoma evacuation than craniotomic hematoma evacuation.